Ankylosing spondylitis is a chronic inflammatory disease that primarily causes pain and inflammation of the joints between the vertebrae of the spine and the joints between the spine and pelvis (sacroiliac joints). More males than females have the disease and onset generally occurs between late adolescence and age 40. Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at significantly increased risk of developing ankylosing spondylitis. There are at least half a million people with AS in the United States but likely more because the disease is under-recognized. AS is more prevalent than multiple sclerosis, cystic fibrosis and Lou Gehrig's Disease combined.
Ankylosing spondylitis may also cause inflammation and pain in other parts of the body as well. Also called spondylitis or rheumatoid spondylitis, ankylosing spondylitis is a chronic condition. Early signs and symptoms of ankylosing spondylitis may include chronic pain in the lower back and hips, especially in the morning and after periods of inactivity as well as stiffness in the lower back or hip area Treatments for ankylosing spondylitis can decrease the pain and lessen the symptoms. Effective treatment may also help prevent complications and physical deformities that sometimes occur along with ankylosing spondylitis.
The condition may change over time, with symptoms getting worse, improving or completely stopping at any point. Over time, the pain and stiffness, which usually begin gradually, may progress up the spine and to other joints. The patient may experience inflammation and pain where the tendons and ligaments attach to bones, in the joints between the ribs and spine, in the joints in the hips, shoulders, knees and feet or in the eyes.
In the advanced stages of the disease, the signs and symptoms include restricted expansion of the chest, chronic stooping, a stiff, inflexible spine, fatigue, loss of appetite, weight loss, eye inflammation (uveitis) and bowel inflammation. As ankylosing spondylitis worsens and the inflammation persists, new bone forms as part of the body's attempt to heal. The vertebrae begin to grow together, forming vertical bony outgrowths (syndesmophytes) and becoming stiff and inflexible. Fusion can also stiffen the rib cage, restricting the lung capacity and function. Inflammation can also involve other parts of the body, resulting in conditions such as inflammatory bowel disease and anemia.
Ankylosing spondylitis doesn't follow a set course. The severity of symptoms and development of complications vary widely from person to person. Complications may include:
> Difficulty walking or standing. Typically, ankylosing spondylitis begins with soreness in the lower back. As the disease progresses, the affected bones may fuse together, rendering the joints immobile and causing a stiff, inflexible spine (bamboo spine). This can make walking or standing difficult. The joints may fuse even with proper treatment - and once joints fuse, additional treatment won't help restore mobility. However, if fusion occurs with the spine in an upright position, the patient can remain more able to perform activities of daily living.
> Difficulty breathing. Inflammation can also spread up the spine and cause the bones in the rib cage to fuse. This results in breathing problems. When the ribs can't move it's difficult to fully inflate the lungs. However, unless the patient has an unrelated lung condition, the patient may be able to continue the everyday activities without experiencing shortness of breath.
> Eye inflammation (uveitis). This complication occurs in up to 40 percent of people with ankylosing spondylitis. It can cause rapid-onset eye pain, sensitivity to light and blurred vision.
> Heart problems. If the inflammation reaches the heart, patients can develop valve problems, such as inflammation of the body's largest artery (aorta), also known as aortitis. Another possible complication is aortic valve regurgitation, which occurs when the aortic ring and aortic valve are distorted.
Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to the joints, such as fusion, especially in positions that limit the function.
The doctor may recommend one or more of the following medications:
> Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs - such as naproxen (Aleve, Naprosyn) and indomethacin (Indocin) - are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve the inflammation, pain and stiffness. However, these medications aren't without side effects. One of the more serious side effects attributed to NSAID use is gastrointestinal bleeding. Rarer side effects include kidney and liver problems.
> Disease-modifying antirheumatic drugs (DMARDs). The doctor may prescribe a DMARD, such as sulfasalazine (Azulfidine) or methotrexate (Rheumatrex), to treat inflamed joints of the legs and arms and other tissues. This class of drugs helps limit the amount of joint damage that occurs. Serious side effects that can occur while using these medications include low blood counts and liver damage.
> Corticosteroids. These medications, such as prednisone, may suppress inflammation and slow joint damage in severe cases of ankylosing spondylitis. They are usually taken orally, ideally for a limited period of time because of their side effects, such as bone loss. Occasionally, corticosteroids are injected directly into a painful joint.
> Tumor necrosis factor (TNF) blockers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers target or block this protein and can help reduce pain, stiffness, and tender or swollen joints. These medications, such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade), may decrease inflammation and improve pain and stiffness for people with ankylosing spondylitis. When taking these medications, there's a risk of reactivating latent infections, such as tuberculosis, as well as a risk of certain neurological problems.
Because genetic factors appear to play a part in ankylosing spondylitis, it's not possible to prevent the disease. However, being aware of any personal risk factors for the disease can help in early detection and treatment. Most people with ankylosing spondylitis don't need surgery. However, the doctor may recommend surgery if there is severe pain or joint damage, or if a nonspinal joint is so damaged that it needs to be replaced. Proper and early treatment can relieve joint pain and may help to prevent or delay the onset of physical deformities.
Physical therapy can provide a number of benefits, from pain relief to improved physical strength and flexibility. Range-of-motion and stretching exercises can help maintain flexibility in the joints and preserve good posture. In addition, specific breathing exercises can help to sustain and enhance the lung capacity. As the condition worsens, the upper body may begin to stoop forward. Proper sleep and walking positions and abdominal and back exercises can help maintain the upright posture. Though the patient may develop spine stiffness despite the treatment regimen, proper posture can help to ensure that the spine is fused in a fixed upright position.
A new, innovative method has proven to help patient's preserve mobility and functionality faster then ever before. The cr17 Hurricane combined with the Camara Myofascial Method utilizes vibration and percussion to more effectively break up adhesions, minimizing the spinal protrusions while promoting greater blood flow within the body and surrounding tissue, enabling the patient to maintain maximum range of motion and strength in a much shorter amount of time than with other treatments and usually with less pain.
The cr17 Hurricane is a groundbreaking pain management device that can be used to effectively treat and reduce the pain of ankylosing spondylitis. A unique physical therapy technology, the cr17 incorporates a concentrated level of vibration and percussion in a single device. When combined with the Camara Myofascial Method, a series of protocols designed to facilitate positive change in the physiological, neurological and biomechanical aspects of the body, these tools can significantly enhance the body's functions.
The goal of ankylosing spondylitis treatment is to relieve the pain and stiffness, and prevent or delay complications and spinal deformity. As the back becomes stiffer and less able to move, the surrounding muscle tissue becomes irritated and agitated, causing abnormal amounts of muscle stiffness, atrophy and loss of motion. As a result, the nervous system is unable to function well which can cause additional pain and muscle spasms.
As a result, relaxing excessive muscle tightness and fascial tension is critical. As a constricting entity, fascia can sabotage the best attempts to relieve pain caused by hypertonic or overly tight muscles. These tight muscles contain highly palpable ropy cords. Patients with spondylosis are especially prone to suffer from pain referred from trigger points in the matrix of these cords. The cords behave not as muscle, but as dense fibrotic tissue. The muscles of the spine must be stretched to overcome this condition.
In fact, the fascia is thicker and more opaque at sites that have been subjected to stresses such as immobility. The greater density at these sites is the fascia's normal reaction to stressors. When traumatized and inflamed, a fascial lesion heals by spider-webbing together with irregularly arranged collagen. Where fascia has been intermittently stressed, fibroblasts produce more linearly arranged collagen to reinforce the loaded myofascia. Diseases such as spondylitis which can cause more sedentary life-styles limit body motions, leaving fascia chronically shortened and nestled closely to adjacent fascia. This immobility, and thus the lack of movement between adjacent fascial sheets, permits fascia's collagen fibers to form intermolecular cross-bonds. In effect, the fascial sheets polymerize into a somewhat continuous, constricting straight-jacket of human flesh, further inflaming the symptoms from the disorder.
Fascia, as well as tendons, capsules, and ligaments, may polymerize and lose its flexibility very quickly as a result of inhibited motion. Fascia adheres to fascia, with collagen fibers coiling in on themselves and shortening over time. Chronically tight or hypertonic muscles create fascial layers that trap and squeeze nerve receptors, along with blood and lymph vessels which create and activate painful trigger points.
A new, innovative method though can heal and resolve the pain of spondylitis faster then ever before. The cr17 Hurricane combined with the Camara Myofascial Method utilizes vibration and percussion to more effectively break up adhesions and promote greater blood flow, enabling the patient to regain full range of motion and strength in a much shorter amount of time than with other treatments and usually with less pain.